by invitation) FORT CARSON, COLO.Our purpose here is to present a surgical approach which we have found successful in dealing with the problem of the internallaryngocele. The pathophysiology and natural history have been recently reviewed by Krekorian," Cody," as well as by ourselves.i' and will not be repeated here. Instead, we would like to direct our attention to a description of the surgical treatment of this lesion.The diagnosis of these lesions has been discussed previously,t-s,lo and will not be discussed in detail. Usually the lesion can be diagnosed by direct laryngoscopy, and the differential diagnostic problems solved by soft tissue films of the neck. In contrast to the findings of others, we have found properly exposed anterior and lateral soft tissue films of the neck more useful than tomograms in diagnosing these lesions. Moreover, the use of Valsalva maneuvers is considered dangerous by somes due to the occasional problem of acute inflation and obstruction.Although Lore" and others have felt that these lesions are adequately controlled by endoscopic excision, we believe that an external approach offers better results. The procedure which we have used is not new. It is an adaptation of procedures described
The comphcations of caustic esophageal trauma are: death, esophageal stricture, perforation, major surgery, and hfelong disabil ity. Reviews have shown that, in the past, stricture could be expected in from 40 to 80 per cent of those with esophageal burns.** Today, with modern therapy, the stricture rate can be reduced to from 3 to 5 per cent.* The purpose of this paper is to describe a form of treat ment which is effective to this end.Over a two year period, seventy patients were admitted to the University of Rochester Medical Center with a history of caustic ingestion. These unselected patients were treated in the following manner:First: an airway was assured, neutralizing substances were ad ministered, and a thorough history and physical examination carried out. The status of the upper alimentary tract was especially noted.Second: a therapeutic program consisting of administration of methylprednisolone sodium succinate in doses of 20 to 40 mgm ini tially and twice a day, antibiotic coverage, and esophagoscopy was undertaken. Penicillin or tetracycUne were administered concur rently.Third: if esophagoscopy showed no burns, the patient was dis charged. If burns were noted, but did not penetrate the mucosa.
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